Chronic disease management conventionally involves routinely monitoring patients to identify health problems before they become medically severe. Chronic disease management may also involve monitoring exercise and diet patterns of patients, as well as adherence to and adjustments of prescribed medicine. A chronic disease that is a major health problem in the United States, and one that often reduces the life span of those who suffer from it, is diabetes mellitus. Diabetes mellitus relates to a group of disorders in which the human body does not produce sufficient insulin and, as a result, blood sugar is elevated. Diabetes management conventionally includes monitoring a patient's blood glucose for abnormalities; monitoring preventative health behaviors such as weight control and fat intake; and monitoring adherence to scheduled insulin regimens.
An important advance in diabetes treatment has been the advent of home blood glucose monitoring wherein glucose meters are used by patients to self-test blood-glucose levels. However, control of blood glucose may require that patients measure their blood sugar 3-4 times per day, record the data, use the data in a formula to adjust their insulin dosage, and frequently communicate the data to a physician or nurse to evaluate their progress. Unfortunately, physicians may not have the time required to review blood glucose data from patients on a regular basis, or to educate and/or motivate patients to follow complicated self-care regimens. Furthermore, some physicians may consider data obtained by patients unreliable and may require patients to come in for an office visit for testing. Requiring patients to make office visits may increase the cost of health care, and may reduce the likelihood that frequent (i.e., daily) adjustments to insulin levels are made.
To overcome the disadvantages of requiring diabetes patients to visit a physician's office, various health care organizations have implemented programs where case managers (i.e., persons with some level of medical training) telephone patients periodically to obtain blood glucose data and other information and to coordinate care. Unfortunately, with often hundreds of patients per case manager, personal contact with individual patients on a daily or even regular basis may be difficult. In addition, personal contact with individual patients on a regular basis may be somewhat expensive. Accordingly, case managers using conventional management techniques may not be able to adjust a patient's insulin dosage as often as necessary to adequately control blood glucose level.
In addition, patients with diabetes may often need feedback and encouragement to continue testing their glucose levels and reporting results to a case manager. Without regular positive feedback, patients may not perform self-tests with enough regularity or may not conduct tests properly.
Another approach used in chronic disease management involves automated voice messaging (AVM) services, wherein patients receive regular telephone calls providing various educational and motivational messages from case managers. Exemplary messages may include reminding a patient of a scheduled physician visit. Some AVM services involve one-way communication, wherein a recorded message is delivered to a patient, but no information is obtained from the patient. As a result, the medical condition of a patient may not be available unless the patient is examined in-person by a physician.
AVM services involving two-way communications may allow patients to respond to AVM telephone queries via a touch tone telephone. Information received from patients may be reviewed by a case manager. The case manager then may identify which patients require callbacks for gathering more detailed information, discussing problems, or providing further information. Unfortunately, AVM services involving two-way communications may require some level of human intervention to identify patients with medically severe conditions that require medical attention, such as a change in insulin dosage. Chronic disease management via AVM has another drawback in that delays may occur between the identification of a patient with a medically severe condition and actual treatment of the condition.